Georgia Sangster explains why social care needs a universalist long term settlement
In September, two years and a pandemic after the Prime Minister’s promised to ‘fix’ the sector, the Government announced its plans for social care. The proposals don’t come close to delivering what is needed – a secure, long-term settlement for a sector in crisis – but it is not just about a lack of funding.
Let’s start with the crisis in social care. It’s true that since Covid we have been hearing more about its problems. If we weren’t already aware, watching carers on our TV screens during the first lockdown, whose care homes were rapidly filling with elderly hospital patients, tell us over and over that they had not been given any PPE, was a strong indication that there were big things wrong in the sector. It’s been since before the financial crash, though, that the Government’s chronic underfunding, deregulation and lack of interest in the sector came to characterise social care.
As a result, 1.5 million people in the UK have unmet care needs. In 2019, 15% of the population over 65 did not have the help they needed to get out of bed, go to the toilet, and wash and dress themselves. That figure has risen 50% since 2010. Those who have navigated the minefield of accessing care can pay enormous costs for it – residential care starts at £600 a week and can run into the thousands for those with complex needs.
It is not just those who need care that the current system fails. The care workforce, the vast majority of which is female, is one of the most overworked, underpaid and undervalued in our society: seven out of ten care workers earn less than £10 per hour. The system also forces millions into the role of unpaid carers, the number of which has increased by around 4.5 million (nearly 60% of them women) to over 13.6 million since the pandemic.
Since social care is provided by local authorities, the poorest areas, where healthy life expectancy rates are lowest, have greater social care needs but less money to pay for them. The 2010 coalition and Conservative government’s austerity policies, which saw central government funding to English local authorities halve in ten years (with an estimated loss of £8 billion for key services like social care) have made this problem worse.
So how exactly does the government plan to fix all this? In 2023, a tax rise of 1.25% on National Insurance Contributions (NICs) will be paid on earnings and dividends and newly applied to the over-65s still in work. Initially nearly all the revenues gained by the rise in NICs will go to addressing the patient backlog in the NHS. Over three years, just £5.4bn will go to adult social care, most of which – £4.9bn – is to change the funding model. Just £500 million is allocated for the professional development of the 1.5 million social care workforce and there is no allocation for increasing pay or recruiting more much needed staff.
In 2025, all the funding from the levy will be diverted to social care but, given the scale of the backlog in the NHS, no one can say how much funding there will be, if there is any left at all. The changes to the funding model are a cap of £86,000 on lifetime personal care costs and a floor in assets, raised to £20,000, below which people will not have to pay for care. These proposals are aimed at protecting people against catastrophic costs, but they will only benefit the very rich. Social care funded entirely by the state will still be restricted, while everyone else will either have to pay £86,000 on their care before they receive any state support or spend down their savings until they are eligible for means-tested care.
The Government’s proposals are not going to fix our broken social care system. Any model in which people have to pay for care means that many will go without the care they need to avoid paying its costs. Such a model will also continue to rely on the unpaid care of family members, mostly women.
We should want more than just to adequately fund a bad system. We need a high-quality, free and universal system of social care whose provision, like the NHS, is based on need and not ability to pay. We need a system whereby people’s needs are met in a way which supports wellbeing and ensures self-determination. This means going beyond a focus on personal care to cover other enriching activities like maintaining relationships and being involved in the community. We need social care to be of a high quality, and this requires a well-trained, well-paid workforce. We need our social care system to reflect the truth – that there is little more important than how we take care of the most vulnerable in our society.